Respiratory Distress Observation Scale (RDOS)

• While high scores should prompt consideration of treatment for dyspnea, this tool does not identify the underlying cause; maintain a broad differential diagnosis and consider other reversible etiologies before initiating palliative interventions.
• The optimal cutoff point has not been definitively established, but the most recent validation study found that scores ≥4 best identified patients with moderate to severe dyspnea.

For scores ≥4, consider palliative treatments to support the work of breathing and enhance comfort, such as opioid therapy, supplemental oxygen, and/or other nonpharmacologic interventions.